On July 19, 2016 Florida Department of Heath announced that it was conducting an investigation into a possible non-travel related case of Zika virus in Miami-Dade County. By August 4, 2016 they found 15 non-travel related cases all located in Miami-Dade and Broward County. The department believes active transmission is only taking place within a one-square mile area in Miami-Dade County.

Presumably many if not all of these non-travel related infections are from autochthonous (local) transmission. Aggressive mosquito control measure are ongoing.

Hillary Clinton takes a top down governmental approach to healthcare. She would defend the status quo: the Affordable care Act (Obamacare) and “make enrollment easier”. She would take a more punitive approach with pharmaceuticals –with regulations to “crack down” on rising prescription drug prices. She would subsidize rising insurance costs with targeted tax credits “of up to $5,000 per family to offset a portion of excessive out-of-pocket and premium costs above 5% of their income.” She would “encourage all states to expand Medicaid”. She makes the rather outlandish claim that she can end the addiction and substance use epidemic “once and for all” through improved treatment, prevention, and training. She favors taxpayer funding of abortions.

Donald Trump takes a less governmental approach. He supports repealing the ACA (Obamacare). He would implement economic incentives and eliminate barriers to make make insurance and pharmaceuticals more competitive. He would subsidize insurance and healthcare costs by tax incentives. He would let Medicaid be administered by the states through block grants. He asserts proper control of the southern border would both decrease the availability of illegal drugs and reduce the medical costs of illegal immigrants. He would seek to liberalize the Republican Party platform’s position on abortion to include exceptions for rape, incest and the life of the mother. He has also said indigent people would be taken care of and wouldn’t be “dying in the streets”

Comment: The ACA (Obamacare) makes healthcare for the poor more affordable –but it is crony capitalism. It promised a few large American health insurance companies huge profits because all individuals must buy insurance, or pay government mandated fines every year. Middle class participation is crucial. Middle class healthy rates and deductibles would go up to subsidize the healthcare of the poor and sick. It is basically a hidden tax on the middle class paid directly to health insurers which benefits the previously uninsured sick and lower classes. The ACA is headed for a financial crisis unless the health insurance programs can pick up the pace of enrollments. Trump will try to improve healthcare costs by incentivizing insurance and pharmaceutical companies to be more competitive. He would have to win many battles in congress to make it work and guarantee care to indigents.

The current zika virus epidemic in Brazil has resulted in increased awareness and active searching for microcephaly -which may have other genetic and in environmental causes. The definition of microcephaly also includes some normal individuals.

The Latin American Collaborative Study of Congenital Malformations (ECLAMC), describes case-cohort studies of pregnant women to answer whether there is a causal relationship between prenatal exposure to the zika virus and microcephaly. Syphilis, toxoplasmosis, rubella, cytomegalovirus and herpesvirus are other infectious causes. Parallel case studies would also include examinations to detect genetic causes.